Physical Therapy Utilization Review Advisor

Physical Therapy Utilization Review Advisor

Requirements

• Master’s degree from an accredited college or university in Physical Therapy required
• Completion of the National Physical Therapy Examination (NPTE) and current license to practice as a Physical Therapist required
• Eight (8) years of related experience or equivalent combination of education and experience required
• Strong knowledge of workers’ compensation regulations and policies
• Knowledge of current trends as it pertains to Physical Therapy, Occupational Therapy, Chiropractic Care, etc
• Extensive knowledge of reviewing, understanding, and applying medical practice guidelines and a range of treatment protocols
• Excellent oral and written communication skills, including presentation skills
• PC literate, including Microsoft Office products
• Analytical and interpretive skills
• Strong organizational skills
• Excellent interpersonal skills
• Excellent negotiating skills
• Ability to create and complete comprehensive, accurate and constructive written reports
• Ability to work in a team environment
• Ability to meet or exceed Performance Competencies

Responsibilities

• Reviews medical records and physical therapy (PT) treatment plans to ensure they meet the appropriate guidelines while also ensuring best possible recovery
• Determines the medical necessity and appropriateness of physical therapy services according to policy and develops action plans for providers as it pertains to current and future treatment
• Provides clinical opinions regarding physical therapy needs and communicates with providers about therapy protocols and guidelines
• Liaises and negotiates with physical therapists, occupational therapists, physicians, and other stakeholders to optimize patient care and promote effective use of resources
• Consults with Sedgwick clinical team on difficult claims and provides recommendations tied to improving care and overall claim outcomes
• Supports clinical product innovation for Sedgwick in conjunction with both internal and external stakeholders
• Documents all communications, decisions, and steps taken in the claim process in a timely and accurate manner
• Participates in client meetings and phone calls to explain program results
• Supports complex claim roundtable discussions
• Participates in quality assurance activities, including audits and peer reviews, to ensure adherence to clinical guidelines and standards, as well as identifying opportunities for improvement
• Stays updated with relevant industry regulations, guidelines, and best practices related to utilization review and maintains compliance with applicable laws and regulations

Preferred Qualifications

• Doctorate degree in Physical Therapy preferred